Fontan术后乳酸水平增高与血流动力学恶化的关系分析

Is an increase in lactate concentration related to hemodynamic deterioration after Fontan procedure?

目的探讨Fontan术后早期乳酸水平改变的规律以及这些改变是否与术后血流动力学状况相关。方法研究对象为10例Fontan手术患儿。纳入标准:体重大于13kg,Glenn术后二期Fontan手术。于入ICU即刻、入ICU30min后、拔除气管插管(拔管)前30min、拔管后30min、拔管后2h、拔管后48h上述6个时点测氧耗指数、血动静脉氧饱和度、乳酸水平,计算心指数。结果入CICU后乳酸水平增加,拔管后30min乳酸水平达到峰值,48h内乳酸值回复正常水平。拔管后30min心指数达到最高水平。中心静脉氧饱和度于拔管前30min达低谷,拔管后逐渐恢复到基线水平。结论 Fontan术后早期,血乳酸水平在拔管后30min达到峰值,该增高与血流动力学状况无关。

Objective To investigate how blood lactate concentration changes after the Fontan procedure,and whether such a change is associated with postoperative hemodynamics.Methods Ten pediatric patients who underwent the Fontan procedure were included.Enrollment criteria were body weight>13 kg and staged Fontan procedure following the bidirectional Glenn procedure.Oxygen consumption index,arterial and ventral venous oxygen saturation,blood lactate concentration were measured at six points:upon,and 30 minutes after intensive care unit(ICU)admission,30 minutes before,30 minutes after,2 hours after,and 48 hours after extubation.Cardiac index(CI)were calculated at above six points.Results Lactate concentration increased in the ICU,reached the maximal value at 30 minutes after extubation,and returned to baseline within 48 hours after extubation.The CI values reached the maximal at 30 minutes after extubation.The central venous oxygen saturation dropped to the minimal level at 30 minutes before extubation,and increased gradually after extubation.Conclusions In the early postoperative period after the Fontan procedure,blood lactate concentration increased temporarily at 30 minutes after extubation but the increase was not associated with hemodynamic deterioration.